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Official Description

Dynamic adjustable wrist flexion only device, includes soft interface material
Short Descr Adjust wrist flexion device
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1E – Other DME
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2025
Action Code A – Add procedure or modifier code (effective 1/1/2025)
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE Not applicable/unspecified.
MUE 2
OTS Orthotic No
Date
Action
Notes
2026-01-01 Added First appearance of addition in codebook.
2025-01-01 Added Code added.
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